Andrew Sullivan's Blog, page 226

Why Not Just Provide The Pill Over The Counter?

Jonathan H. Adler considers the question:

A final step the administration could take would be to enhance access to contraception by making all forms of oral contraception available over-the-counter without a prescription (and not just “Plan B”).  While this would not make contraception “free” it would reduce the cost, and help alleviate some of the non-monetary obstacles women face.  As Adrianna McIntyre notes, cost is hardly the only (or even the largest) obstacle working women face when it comes to obtaining contraception.  Making oral contraception available OTC might not help the 3-4 percent of women who use IUDs, but it would nonetheless expand access to contraception as a practical matter, particularly for the working poor.  It also has the support of some prominent conservatives and would largely eliminate the cultural conflict engendered by the mandate.

One such conservative is Philip Klein:

Philosophically, it’s consistent with limited government principles. It removes unnecessary government regulations and increases choice. It doesn’t impose new burdens on businesses or religious institutions, nor does it require an increase in government health care spending.

And politically, it would also be beneficial to Republicans. It would make it a lot more difficult for Democrats to portray the GOP as being only interested in obstructing Democrats rather than supporting their own ideas, and harder to accuse Republicans of being broadly against access to birth control. Instead, it would allow Republicans to go on offense, and show that Democrats are the ones who want to play politics with birth control.

Ben Domenech, another conservative, runs through the counterarguments:

There are a number of objections to [OTC birth control], but I find them to largely amount to unconvincing paternalism.

The chief argument advanced is that standard oral contraceptives mess with hormones and have all sorts of side effects. This is, of course, true! But: dangerous side effects are rampant within all sorts of other over the counter drugs. Women can think for themselves and make decisions with their doctor and pharmacist about what drugs they want to take – and the evidence shows they are good at self-screening. In fact, it would actually increase the ability to mitigate and respond to unanticipated side effects, since changing tracks will no longer require a doctor’s visit and getting a new prescription. Assuming that women won’t or can’t take responsibility for themselves to consult with a doctor unless required to by arbitrary government policy is absurd.

Allahpundit spotlights one of the idea’s most vocal supporters:

Bobby Jindal, who’s wooing religious conservatives ahead of 2016, has been pushing [the OTC pill] since 2012.  … Congress could, as Jindal suggests, even adjust Health Savings Accounts so that they include OTC medicines, which would further reduce the financial burden. And politically, it would complicate the Democrats’ dopey “war on women” messaging by decoupling the contraception debate from the debate over abortion. How do you push a “Republicans don’t believe in reproductive freedom” message if GOPers like Jindal want to make the pill OTC?

But the best endorsement comes from the OCOG:

In the United States, the proposal to sell oral contraceptives over the counter has been endorsed by the premier body of relevant experts, the American Congress of Obstetricians and Gynecologists. Ultimately, though, the decision will be made by the FDA.

So why the holdup? Elizabeth Nolan Brown has a must-read:

“Doctors regularly hold women’s birth control prescriptions hostage, forcing them to come in for exams,” wrote Stephanie Mencimer in a Mother Jones piece about her own doctor doing so. Dr. [Jeffrey] Singer described as it doctors extorting pay for a “permission slip” to get the same medication over and over again. Feminist blogger Amanda Marcotte says doctors use “the pill as bait” to make sure women come in once a year. Both doctors and public health officials publicly worry that women won’t receive annual cervical cancer and sexually transmitted infection (STI) screenings without such coercion. How much of this concern is motivated by profit, how much by paternalism, is hard to say. …

It’s not just some doctors and medical groups who want to keep things status quo. Pharmaceutical companies also gain from it. OTC sales “would drive down the prices substantially,” says Singer. Drugmakers can get higher prices from insurance companies than they could in a competitive contraceptive market. … Yet the pharmaceutical industry is the only entity with standing to challenge the prescription status of current birth control pills. In order to initiate the switch from prescription to nonprescription, a drug maker must approach the FDA.

How Lame Is HRC?

I’m a broken record on this, but I have less respect for HRC, the country’s largest gay rights lobby, than I do for AIPAC. AIPAC may weaken the US, but at least it gets shit done. HRC? Not so much. Case in point – at New York’s Gay Pride Parade, they apparently couldn’t even muster a real contingent for the march, according to mischievous eye-witnesses, recruiting a bunch of 20-somethings from an ad agency – McCann:

Numbering perhaps 30, they were outdone by the delegations of many smaller community groups as well as their fellow corporate sponsors. Walmart’s envoys stretched a block and a half; MasterCard’s crowd was loud and proud … But it seems that HRC, the largest — and richest — LGBT-rights group in the country, could not be bothered to field a team for the largest LGBT-pride parade in the country. Nor did the earnest, well-meaning boys and girls who marched in their stead have much of an idea why they were there. Some clearly thought we and our banner were part of their group. One wasn’t sure what “HRC” stands for, though most gamely chanted “H! R! C!” — corporate cheerleaders shilling for our premier civil-rights organization right down the lavender line. And no one was sure if there were any HRC staffers among them; if there were, I couldn’t find any.

Chad Griffin couldn’t show up?

Unsafe At Any Speed?

Based on his personal experience, Alexander Zaitchhik fears that off-label use of ADHD drugs is a “public health disaster”:

Around 2009, I noticed more friends and acquaintances getting scripts. These people would never in a million years be caught facedown in a caterpillar of street meth, but here they were singing in the rain about Adderall – Kate Miller’s “medicine.” More than one of these people asked me, “Why are you paying $20 a pill?” They suggested doing what they did: take an online quiz, find a friendly [Attention Deficit Disorder Association]-approved doctor who “gets it,” and get sorted in a doctor’s office.

I never considered it. A cheap and limitless supply of pharma-grade amphetamine, signed off by a friendly medical professional, struck me as an incredibly unwise pursuit. That’s how you become a heavy or daily user. The road to tweakdom is paved with Duane Reed co-pay receipts. I’ve since been proved right, sadly, by watching speed hurt people I care about. …

For those who have never taken speed, it’s difficult to convey the seriousness of a public health disaster – and the depths of its underlying corruption – that results in healthy college students taking 90 daily milligrams of amphetamine salts under blasé doctor’s orders. At 90 milligrams a day, the question is not if the person will eventually experience some form of speed psychosis, but what grade and when.

Previous Dish on Adderall here, here, and here.

Say Goodbye To Pi?

Randyn Charles Bartholomew summarizes the case against π – and for tau, otherwise known as 2π:

The crux of the argument is that pi is a ratio comparing a circle’s circumference with its diameter, which is not a quantity mathematicians generally care about. In fact, almost every mathematical equation about circles is written in terms of r for radius. Tau is precisely the number that connects a circumference to that quantity.

But usage of pi extends far beyond the geometry of circles. Critical mathematical applications such as Fourier transforms, Riemann zeta functions, Gaussian distributions, roots of unity, integrating over polar coordinates and pretty much anything involving trigonometry employs pi. And throughout these diverse mathematical areas the constant π is preceded by the number 2 more often than not. Tauists (yes, they call themselves tauists) have compiled exhaustively long lists of equations—both common and esoteric, in both mathematics and physics—with 2π holding a central place. If 2π is the perennial theme, the almost magically recurring number across myriad branches of mathematics, shouldn’t that be the fundamental constant we name and celebrate?

The Magic Middle Kingdom

Lily Kuo surveys China’s booming amusement-park industry:

In all there are already more than 2,000 theme parks in China already, according to estimates by Chinese tourism experts, compared to just over 400 in the United States, with another 64 due to launch in the next six years. It’s no wonder global entertainment firms from Six Flags to Disney, which is building a Disneyland in Shanghai, are clamoring to enter the Chinese market: More than 108 million people visited theme parks in China last year, up 6 percent from 2012, and Chinese theme park groups like Oct Parks China, Fantawild Group, and Haichang Group, have entered global rankings [pdf] in terms of attendance.

(Photo of Guangzhou’s Chimelong Paradise by Flickr user davecobb)

Going With Your Gut

Psychologist Gerd Gigerenzer defends the practice, arguing that we “need statistical thinking for a world where we can calculate the risk, but in a world of uncertainty, we need more.” How ignoring the importance of instincts and gut feelings hurts business practices:

Gut feelings are tools for an uncertain world. They’re not caprice. They are not a sixth sense or God’s voice. They are based on lots of experience, an unconscious form of intelligence.

I’ve worked with large companies and asked decision makers how often they base an important professional decision on that gut feeling. In the companies I’ve worked with, which are large international companies, about 50% of all decisions are at the end a gut decision. But the same managers would never admit this in public. There’s fear of being made responsible if something goes wrong, so they have developed a few strategies to deal with this fear. One is to find reasons after the fact. A top manager may have a gut feeling, but then he asks an employee to find facts the next two weeks, and thereafter the decision is presented as a fact-based, big-data-based decision. That’s a waste of time, intelligence, and money.

The more expensive version is to hire a consulting company, which will provide a 200-page document to justify the gut feeling. And then there is the most expensive version, namely defensive decision making. Here, a manager feels he should go with option A, but if something goes wrong, he can’t explain it, so that’s not good. So he recommends option B, something of a secondary or third-class choice. Defensive decision-making hurts the company and protects the decision maker. In the studies I’ve done with large companies, it happens in about a third to half of all important decisions. You can imagine how much these companies lose.

Much More Than Still Life

In a review of The Barnes Foundation’s exhibit The World Is an Apple: The Still Lifes of Paul Cézanne, Morgan Meis considers why the painter’s still lifes provoked outrage in the late 19th century and why they endure as “so peculiar, so specifically Cézanne-ish” today:

Cézanne liked his painting surfaces rough with paint. He generally did not varnish or glaze his paintings. He also didn’t care much for “correct” perspective. Look, for instance, at The Kitchen Table (1888-90). The left corner of the table doesn’t even match up with the right corner. And the floor of the kitchen doesn’t recede properly into space. Cézanne didn’t care. He wanted the painting to look this way. He wanted you to feel – when looking at the painting – slightly off-kilter, like the canvas can’t quite hold what is inside it and the kitchen might spill forward out of its frame.

Cézanne also liked to blur lines and boundaries within his paintings.

In Apples and Cakes (1873-77), there is a green object, probably an apple, at the back of a white dish of fruit. The apple is the exact color as the wall behind the table. So, it looks as if the wall, in the background, has simply bled into and become part of the bowl of fruit in the middle ground. In Still Life with Seven Apples and a Tube of Paint (1878-9), Cézanne has scraped at the apples with some sort of knife, mixing the colors and boundaries of the middle apple into the apples next to it. In Still Life with Carafe, Milk Can, Bowl, and Orange (1879-80), the carafe barely exists, since it merges into the colors and shapes of the wall behind it and the other objects nearby. Many things seem to be merging in Cézanne’s paintings. Objects merge with one another. Background and foreground merge. Space itself seems to tighten and overlap.

It is as if Cézanne painted still lifes to show that individual objects sitting on a table are not individual objects at all. Sure, an apple is just an apple. But in Cézanne’s still lifes, an apple isn’t just an apple. It is also all the other apples. And it is the table and jug and the pitcher and the wall behind the table. Every object is implicated in every other object. To look at one object you have to look at all the others. To confront one individual thing, you have to confront a whole world.

(Image: The Kitchen Table by Cézanne, 1888-90, via Wikimedia Commons)

To Be A Christian In The “Islamic State”

Well, you may be able to imagine. Andrew Doran and Drew Bowling report on the plight of Mosul’s terrified Christians:

On June 23, the Assyrian International News Agency reported that ISIS terrorists entered the home of a Christian family in Mosul and demanded that they pay the jizya (a tax on non-Muslims). According to AINA, “When the Assyrian family said they did not have the money, three ISIS members raped the mother and daughter in front of the husband and father. The husband and father was so traumatized that he committed suicide.”

Although few reports from ISIS-occupied Iraq can be corroborated, the group’s record of torture chambers, public executions, and crucifixions lends credibility to nightmarish accounts from the ground. Since the fall of Mosul, a litany of evils has replaced the liturgies of the Christians there: a young boy ripped from the arms of his parents as they ran from the ISIS advance and shot before their eyes, girls killed for not wearing the hijab.

Small wonder that since the fall of Mosul, tens of thousands of defenseless civilians have fled the ISIS onslaught, including the region’s Christians, whose presence on the Nineveh plains dates back to the earliest centuries of Christianity. Most have left their homes with nothing but the clothes on their backs.

Meanwhile, some Iraqi Christians are turning to Putin as a possible savior:

“Russia proved through history that it’s the only defender of Christians,” said Ashur Giwargis, who heads the Assyrian Patriotic Movement (APM), which for two years has energetically lobbied the Kremlin to support an independent Assyrian Christian state in northern Iraq. Until recently, the Beirut-based exile and his colleagues, who are scattered among the global Iraqi diaspora, had little to show for their efforts, but in January, as Western-Russian tensions escalated over Ukraine, Giwargis was summoned to Moscow to meet government officials. …

There are few assurances that Russia—which is already held in low regard by much of the Arab World for its stance on Syria—will further jeopardize its relations across the region by throwing its weight behind Iraq’s Christians. Nor, for that matter, does APM’s courting of Putin necessarily command serious support among many Iraqi Christians, of whom only 10-15 percent favor its pro-active approach, according to several church officials.

But the APM’s fishing for alternative patrons is illustrative of the tremendous anger many Eastern Christians feel towards the West for its perceived indifference to their plight.

(Photo: A Iraqi girl fleeing from the city of Mosul arrives at a Kuridish checkpoint. ISIS has captured major roads and town in central Iraq. June 12, 2014. By Sebastiano Tomada/Getty Images.)

Hobby Lobby Wins: Reax II

an illustrated guide to american personhood. #scotus #HobbyLobby pic.twitter.com/nYGatBJj8E

— Sarah Baker (@bakerbk) June 30, 2014

Our early roundup of blog commentary is here. My initial take on the ruling is here. Your thoughts are here and here – and we’re compiling many more. From the next wave of blog commentary, Amy Davidson seizes on several quotes from Ginsburg’s dissent and anguishes over the majority decision:

Alito sees all the substance in how put-upon the owners of corporations feel. In oral arguments, Kennedy openly worried that companies would somehow be mixed up with abortion, and one suspects that his sense that abortion is a distinctly volatile, morally charged subject was part of why he acquiesced here, and why seems to believe, against all reason, that this decision is narrow. Women’s health is treated as something troublesome—less like other kinds of health care, which a company should be asked to pay for, than as a burden for those who have to contemplate it.

Soraya Chemaly is on the same page:

Ninety-nine percent of sexually active women will use birth control at some point in their lives. The Court’s decision displays the profound depth of patriarchal norms that deny women autonomy and the right to control our own reproduction—norms that privilege people’s “religious consciences” over women’s choices about our own bodies, the welfare of our families, our financial security and our equal right to freedom from the imposition of our employers’ religious beliefs. … This religious qualifier was narrowly construed to address just this belief and not others, such as prohibitions on vaccines or transfusions. It is not a coincidence that all three female members of the Court and only one man of six dissented from this opinion.

Drum is also bummed:

This is not a ruling that upholds religious liberty. It is a ruling that specifically enshrines opposition to abortion as the most important religious liberty in America.

But McArdle doesn’t buy such sweeping statements:

Here’s a representative tweet from my feed this morning: “So let’s all deny women birth control & get closer to harass them when they’re going in for repro health services. BECAUSE FREEDOM.” Logically, this is incoherent, unless you actually believe that it is impossible to buy birth control without a side payment from your employer. (If you are under this tragic misimpression, then be of good cheer! Generic birth control pills are available from the drugstore for about $25 a month.) Otherwise, according to the reasoning of that tweet, I am being denied something every time my employer refuses to buy it for me: cars, homes, Hummel collectible figurines. …

Now, there are women out there for whom a few dollars a month is a crippling expense, but I venture to say that few of them are salaried workers getting health insurance from closely held corporations with deeply religious owners; most of them will be hourly workers on Medicaid.

Suderman counters critics of the court’s view that “corporations are people”:

The key to Alito’s ruling arguably comes down to just two words: “a person’s.” The big question isn’t whether the contraception mandate violates the religious freedoms of some faceless corporate entity entirely separate from the individuals who own that company—it’s whether the requirement would violate the free exercise of religious for the particular people who founded and now run the company. As Alito writes in his opinion, “A corporation is simply a form of organization used by human beings to achieve desired ends….When rights, whether constitutional or statutory, are extended to corporations, the purpose is to protect the rights of these people.”

Ilya Somin adds on that score:

Even the dissent by Justice Ruth Bader Ginsburg partially recognizes this, since she accepts that [the Religious Freedom Restoration Act] does apply to nonprofit religious corporations, such as those established by churches. The latter, of course, are no more natural “persons” than for-profit corporations are. In modern society, people routinely use corporations for a wide range of activities. Numerous employers, churches, schools, newspapers, charities, and other organizations use the corporate form. When they do so, their owners and employees should not have to automatically check their constitutional and statutory rights at the door.

Meanwhile, Aaron Blake notes something I mentioned last night: the court’s metric of “closely held” – defined by the IRS as companies in which five or fewer individuals own more than half the stock – affects about 90 percent of all businesses and about 50 percent of all employees. Blake then asks:

But does that mean the employers of half of all Americans will suddenly nix contraception coverage?

Of course not. According to a Kaiser Family Foundation poll, 85 percent of large employers had already offered contraception coverage before Obamacare mandated it. And while Hobby Lobby fought that mandate, so far few other large companies have joined them. … [T]here is little reason to believe that tens of millions of American women will suddenly see their contraception coverage come to an end.

And for those who do lose their coverage, Danny Vinik reminds us that “employees of closely held corporations may receive contraceptive coverage anyway”:

That coverage would likely mimic the workaround developed in 2012 by the Department of Health and Humans Services. That regulation exempted nonprofit religious institutions like hospitals and charities (churches were already exempt) from adhering to the contraceptive mandate. However, it required insurance companies to offer contraceptive coverage free of charge to those employees. This workaround, the Obama administration argued, ensured that religious institutions were not directly participating in offering contraception to their employees.

In fact, Alito essentially recommends that workaround in his ruling. Cohn takes that one step further to argue that “the obvious solution to this dilemma is to take health insurance away from employers altogether” and give it to “the government or tightly regulated insurers”:

But the people and groups who oppose government’s providing insurance directly tend to be the same people who object to the contraception mandate. That’s not a coincidence. While I don’t doubt the religious objections to birth control are sincere, I do think they are masking another belief conservatives bring to this debate: As a general rule, conservatives don’t think government should be compelling them to pay for other people’s medical expenses.

As Beutler puts it, “Ironically, and appropriately, the ruling probably prefigures a call for a greater, not smaller, government role in the health care system.” Still, any such workarounds probably won’t satisfy companies like Hobby Lobby:

To take advantage of the exemption, a closely held company owned by religiously devout individuals must file a form, specified by the government, in order to trigger the legal duty of the “middle man” to provide the coverage as a stand-in for the company or its owners. Federal government lawyers have made it clear in court, over and over again, that the “middle man” will not have any authority to step in unless the company or its owners file that government form claiming an exemption for the mandate. Some whose religions tell them to have nothing to do with some forms of birth control (often on the premise that they amount to a form of abortion) believe that even the filing of that formal declaration is itself an act of participation in the provision of those very services for people on their payroll.

And that argument is winding its way through the courts:

At least 51 nonprofit lawsuits have been filed against the administration’s policy by groups that say the accommodation still forces them to violate their religious beliefs since they have to arrange for the contraception coverage. Some of those challenges have reached the appellate court level, and just this past New Year’s Eve, Justice Sonia Sotomayor temporarily blocked the administration from enforcing the requirement against the Little Sisters of the Poor, a group of Colorado nuns.

As SCOTUSblog pointed out over the weekend, two more religious-affiliated groups on Friday asked for a similar protection from the contraception rule. “It is now nearly a certainty” that the Supreme Court will take up the nonprofit challenges to the contraception requirement next term, according to SCOTUSblog.

The Best Of The Dish Today

SCOTUS decision is a victory for unborn babies! #hobbylobby

— toddstarnes (@toddstarnes) June 30, 2014

I’m grateful for your many emails on the Hobby Lobby ruling. Almost all of them are dissents. And there’s one core point that we didn’t underline today that’s worth noting. When you consider this a “narrow” ruling because it is restricted to “closely-held” companies (i.e. those with “more than 50 percent of the value of its outstanding stock owned directly or indirectly by five or fewer individuals at any time during the last half of the tax year” and “not a personal service corporation”), you find that over 90 percent of companies in this country fit the bill. That’s not-so-narrow in the broad scheme of things. Alison Griswold notes:

According to a 2009 research paper from NYU Stern School of Business, these corporations account for 52 percent of private employment and 51 percent of private-sector output in the country.

Will they all decide they cannot furnish certain medications, based on religion? Of course not. But they could. And when the potential scope of this sinks in, and especially if more than a few companies start curtailing their female employees’ health coverage for religious reasons, I’d say you’re going to have a very divisive reaction.

Which raises the politics of this. I’d say it’s terrible for the right in everything but the short term. It may fortify the base, but the fact that this decision focuses exclusively on medications for women, and not for men, will surely fortify the other base even more. Even if you worry about religious liberty, why does religion in 21st Century America always seem to be about policing the sex lives of everyone but straight men? That may not be the intent of the ruling, but it is somehow always the effect. It’s not good PR. And neither is this attitude:

Ohmydeargawd, women might have to go to Target for birth control. #MiddleAges

— John Nolte (@NolteNC) June 30, 2014

I have a feeling that the lack of any female votes in the majority will also sink in. If the Republicans want to add fuel to the Democrats’ charge of a “War on Women”, they just got a tank of gasoline. And this could even be a real fault-line in upcoming national politics. Bobby Jindal is now running as the religious freedom candidate; Hillary Clinton will be the first woman candidate for president with bells on. She has already declared the ruling “deeply disturbing.”

I’d say the gender gap just widened a bit more; and the Democrats – especially young and single women – have just been given a reason to turn out this November and in 2016. As often with culture war battles, the winners can easily become losers. And I don’t need to remind the right that those who have no problem with contraception are a growing, big majority demographic and those opposed to contraception are a tiny and declining one. If you’re going to take a stand on religious conscience, why does it have to be restricting women’s choices in their insurance coverage?

In non-Hobby Lobby news, we noted Facebook’s creepy manipulation of  users’ emotions – all for your own good, you understand; Putin got his comeuppance as Ukraine signed a trade pact with the EU; and I penned a mediation on our age of libertarianism – and its growing impact on foreign policy.

The most popular (well, read, anyway) post of the day was Why Am I Not So Alarmed By Hobby Lobby? followed by Jesus vs John Galt. I can’t help wondering if part of the Court’s rationale isn’t somehow informed by American conservatism’s bizarre and disturbing attempt to create a Randian Christianity.

Many of today’s posts were updated with your emails – read them all here.  You can always leave your unfiltered comments at our Facebook page and @sullydish. 15 more readers became subscribers today. You can join them here - and get access to all the readons and Deep Dish - for a little as $1.99 month.

See you in the morning.